Peripheral Artery Disease

Peripheral artery disease (PAD) is a slow and progressive circulation disorder caused by narrowing, blockage or spasms in a blood vessel.

PAD may involve disease in any of the blood vessels outside of the heart including the arteries, veins or lymphatic vessels. Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

The terms "peripheral arterial disease" and "peripheral vascular disease" are often used to describe the same condition.

Causes

PAD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis, the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.

Symptoms

Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest).

Other symptoms may include:

Changes in skin, including decreased skin temperature or thin, brittle, shiny skin on the legs and feet

Diminished pulses in legs and feet

Gangrene

Hair loss on legs

Impotence

Non-healing wounds over pressure points, such as heels or ankles

Numbness, weakness or heaviness in muscles

Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat

Pallor (paleness) when legs are elevated

Reddish-blue discoloration of the extremities

Restricted mobility

Severe pain when the narrowing of the artery is significant or totally blocked

Thickened, opaque toenails

Diagnosis

In addition to a complete medical history and physical exam, other tests may include:

Angiogram: An X-ray of the arteries and veins to detect blockage or narrowing of the vessels

Ankle-brachial index (ABI): A comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device